GERD

• Gastroesophageal reflux disease (GERD) is defined as a significant symptomatic condition presume to be secondary to reflux of gastric content into the lower esophagus
• Predisposition:

  • incompetent lower esophageal sphincter
  • decrease esophageal clearance
  • decrease gastric emptying
  • hiatal hernia
• Acidic secretion regurgitated in the lower esophagus results in irritation and inflammation
• Clinical manifestations

  • pyrosis (heartburn)
  • globus or choking sensation
  • regurgitation
  • early satiety
  • bloating after a meal
  • nausea and vomiting
  • dysphagia or odynophagya (painful swallowing)
  • coughing, sore throat, horseness
• Complications

  • esophagitis
  • esophageal stricture
  • Barrett’s esophagus (precancerous lesion)
  • esophageal cancer
  • resp conditions
  • dental erosion
• GERD is often diagnosed on the basis of symptoms or past medical history. Other diagnostic studies are barium swallow, gastroscopy and biopsy
• Lifestyle modifications

  • elevate head of bed, especially after meals
  • stop smoking
  • weight loss
• Nutrition therapy

  • avoid fatty food, chocolate, peppermint, alcohol, milk products and late night snacks
  • encourage small frequent meals and taking fluids between meals instead of during
  • avoid intake of acid pH beverages (orange juice, tomato based products)
• Medication therapy

  • increase lower esophageal sphincter pressure: cholinergic
  • Promotility: prokinetic
  • Acid neutralizing: antacids
  • Anti-secretory: H2 receptor blockers, proton pump inhibitors